Abstract

Ground crossing borders in the Middle East and North Africa (MENA) region are vital for trade, migration, and humanitarian relief, yet they remain critical weak points in global health security. Their vulnerability stems from fragile infrastructure, limited resources, and weak surveillance systems, exacerbated by conflict, climate-related disasters, and rising forced migration. These dynamics increase disease transmission and overwhelm national health systems. Although the International Health Regulation IHR 2005 require countries to build core public health capacities at Points of Entry (PoEs), implementation at land borders remains challenging due to their porous and complex environments. This study aims to identify key pillars of effective border health management, assess health core capacities on the land borders in selected MENA countries, and explore implementation challenges and solutions from expert perspectives.

A scoping review was conducted using Arksey and O’Malley’s framework and PRISMA-ScR guidelines, covering literature from 2005 to 2023 across PubMed, Scopus, Web of Science, and UN databases. Forty-five eligible studies were grouped into eight thematic areas. These themes informed a descriptive exploratory survey targeting public health and border management professionals across the region. The survey assessed the current status of IHR (2005) core capacities through eight themes: Infection Prevention and Control (IPC), Coordination and Partnerships, Research and Data Sharing, Border Health Capacity, Planning, Communication, Legal Frameworks, and Services for At-Risk Groups. Responses were analyzed both quantitatively and qualitatively.

The scoping review identified eight interlinked themes essential for effective border health management. The survey findings revealed an average IHR (2005) readiness of 46% among selected MENA countries, with most thematic areas showing significant gaps. Stronger performance was linked to targeted investment in health security rather than overall economic strength. The most critical deficiencies were found in surveillance and data-sharing systems, indicating weak knowledge exchange and evidence-driven planning. Other thematic areas— including IPC, emergency planning, legal frameworks, and support for vulnerable populations—also showed substantial weaknesses, underscoring the need for systemic reforms.

Ground crossings in the MENA region are underprepared to manage cross-border health threats. Their complexity requires tailored approaches beyond the current IHR (2005) assessment tools. Strengthening IHR implementation will depend on context-specific strategies: revising assessment frameworks to reflect ground realities, expanding digital surveillance, building workforce capacity, and improving regional coordination. Sustainable funding and integrated, multisectoral approaches are essential to enhance health preparedness and migration response. This study offers evidence-based insights and actionable recommendations to improve health security at land borders in fragile settings.

School

School of Sciences and Engineering

Department

Institute of Global Health & Human Ecology

Degree Name

PhD in Applied Sciences

Graduation Date

Spring 5-2025

Submission Date

5-25-2025

First Advisor

Sungsoo Chun

Committee Member 1

Fayrouz Ashour

Committee Member 2

Maysa Ayoub

Committee Member 3

Ahmed Mandil, Nessrin El-Nimr, Anwar Abdelnaser

Extent

130 p.

Document Type

Doctoral Dissertation

Institutional Review Board (IRB) Approval

Approval has been obtained for this item

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Available for download on Tuesday, May 25, 2027

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